Basic Information
| Provider Information | |||||||||
| NPI: | 1316300650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMAYA | ||||||||
| FirstName: | JULIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6309 SANTO DOMINGO ST NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871202280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059221514 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2221 RIO GRANDE BLVD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871042529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058301871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2016 | ||||||||
| LastUpdateDate: | 04/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | T0180401 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.